National Child Research Articles

Socio-Economic Perspectives of Household Water Treatment for Safe Drinking in Nigeria

Access to safe drinking water remains a huge challenge to households in developing countries of which Nigeria is one. This is evident from the numerous cases of water related diseases ravaging the country. The United Nations Children Emergency Fund reports that over 150,000 Nigerians and about 117, 000 under five children, die of water borne diseases annually. Since safe water is gotten from water treatment, the challenges associated with ensuring that water is adequately treated for the households are enormous. Considering that the household is generally the primary source of drinking water for the populace, the socio-economic characteristics of a household plays a key role in determining their access to quality water for drinking. It is based on this that this study seeks to evaluate how household socio-economic characteristics influences a household’s decision to treat its drinking water. The study uses the Binary Logistic regression model to test for the correlates of household water treatment decisions. The data employed in this study is sourced from the Multiple Indicator Cluster survey conducted by UNICEF. A total of 26359 households were selected for the study. The study shows that about 23,495 of the selected households do not treat their water for safe drinking in Nigeria. The result also shows that source of drinking water is a key determining factor in the water treatment decisions of households, as different sources of water were found to have varying degrees of effects on water treatment decisions by households. Some ethnic groups were also observed to have a poor water treatment culture. Also, education of household head and high wealth status increases water treatment.

MR-guided focused ultrasound in pediatric neurosurgery: current insights, technical challenges, and lessons learned from 45 treatments at Children's National Hospital.

MR-guided focused ultrasound (MRgFUS) is an evolving technology with numerous present and potential applications in pediatric neurosurgery. The aim of this study was to describe the use of MRgFUS, technical challenges, complications, and lessons learned at a single children's hospital. A retrospective analysis was performed of a prospectively collected database of all pediatric patients undergoing investigational use of MRgFUS for treatment of various neurosurgical pathologies at Children's National Hospital. Treatment details, clinical workflow, and standard operating procedures are described. Patient demographics, procedure duration, and complications were obtained through a chart review of anesthesia and operative reports. In total, 45 MRgFUS procedures were performed on 14 patients for treatment of diffuse intrinsic pontine glioma (n = 12), low-grade glioma (n = 1), or secondary dystonia (n = 1) between January 2022 and April 2024. The mean age at treatment was 9 (range 5-22) years, and 64% of the patients were male. With increased experience, the total anesthesia time, sonication time, and change in core body temperature during treatment all significantly decreased. Complications affected 4.4% of patients, including 1 case of scalp edema and 1 patient with a postprocedure epidural hematoma. Device malfunction requiring abortion of the procedure occurred in 1 case (2.2%). Technical challenges related to transducer malfunction and sonication errors occurred in 6.7% and 11.1% of cases, respectively, all overcome by subsequent user modifications. The authors describe the largest series on MRgFUS technical aspects in pediatric neurosurgery at a single institution, comprising 45 total treatments. This study emphasizes potential technical challenges and provides valuable insights into the nuances of its application in pediatric patients.

Neonatal sex and maternal factors associated with small-for-gestational-age neonates: A nationwide population-based study.

Small-for-gestational-age (SGA) newborns have a higher risk of morbidity and mortality. Recognizing the risk factors for SGA helps raise early awareness of the issue and provides valuable insights for both healthcare providers and pregnant women. We aimed to identify determinants of SGA using population-based databases in Taiwan. Data were retrieved from the National Health Insurance, Birth Reporting, and Maternal and Child Health databases for this nationwide case-control study. Live births between 20 and 44 weeks of gestation from 2005 to 2014 were enrolled and linked to their mothers to determine maternal conditions during pregnancy. For every SGA newborn, four controls matched by gestational age and birth year were randomly selected. Multivariable logistic regression was used to identify risk factors for SGA, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) accounting for potential confounders and interaction terms. A total of 158,405 live SGA births were identified, with 623,584 controls randomly selected. Independent risk factors for SGA included maternal age <20 years (aOR 1.68, 95% CI 1.62, 1.75); female sex in newborns (aOR 1.28, 95% CI 1.27, 1.30); socioeconomic deprivation (aOR 1.29, 95% CI 1.21, 1.38); hypertension (aOR 1.6, 95% CI 1.52, 1.67); kidney disorders (aOR 1.29, 95% CI 1.16, 1.44); thyroid disorders (aOR 1.13, 95% CI 1.09, 1.17); systemic lupus erythematosus (aOR 2.59, 95% CI 2.33, 2.89); antiphospholipid syndrome (aOR 2.08, 95% CI 1.64, 2.64); gestational hypertension (aOR 1.69, 95% CI 1.61, 1.76); pre-eclampsia (aOR 3.12, 95% CI 3.01, 3.25); and antepartum hemorrhage (aOR 1.05, 95% CI 1.03, 1.07) after adjustment for other covariates. SGA was associated with younger maternal age, female newborns, underlying comorbidities, and obstetric conditions. Gestational hypertension and pre-eclampsia were significant risk factors affecting infants of both sexes and all age groups and could mask the effects of maternal age and infant sex.

COVID-19 vaccination campaigns in fragile and conflict-affected settings, Somalia.

By 31 December 2021, only 5.5% (861 879/15 670 530) of the Somali population had been fully vaccinated against coronavirus disease 2019 (COVID-19). To rapidly increase COVID-19 vaccine coverage in 2022, the health ministry and its partners (World Health Organization and United Nations Children's Fund) adopted a more responsive strategy. This strategy included careful microplanning, better targeting of populations and providing people-centred vaccination services close to their homes. These services were combined with childhood vaccination and basic health-care provision using the existing polio network and community health workers. Additionally, a digital tool for recording COVID-19 vaccination data and a mobile phone-based electronic registration system were introduced. Somalia, a fragile and conflict-affected state, faced challenges when implementing COVID-19 vaccination, including inexperience in managing mass adult vaccination, inadequate infrastructure and health workforce. Furthermore, insecurity in some areas and severe drought resulted in large-scale displacement of people. The implementation of a more context-specific strategy helped Somalia reach substantially more people with COVID-19 vaccination and 42.1% coverage by 31 December 2022. Additionally, 84 600 zero-dose children received their first childhood vaccine during the integrated campaigns. The increased coverage has led to public health benefits that outweigh the investment in the COVID-19 vaccination campaigns. Successful roll-out of adult vaccination is achievable even in a fragile and conflict-affected setting through implementation of a tailored contextualized approach. Key factors include good microplanning, use of digital tools, better population-targeting, bundling vaccines together and delivering vaccination services close to people's homes.

35: ECMO training course for pediatric critical care staff: A report from National Children Center from China

35: ECMO training course for pediatric critical care staff: A report from National Children Center from China

Measuring breastfeeding prevalence using demographic and health surveys

BackgroundThis study aims to investigate the measurement of breastfeeding prevalence indicators using Demographic and Health Surveys (DHS) data, focusing on early initiation, exclusive breastfeeding, and continued breastfeeding indicators as reported by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) and on the discrepancies arising from small changes in their definition.MethodsTwo hundred sixty DHS samples from 78 countries were analyzed to re-calculate usual indicators reported by WHO and UNICEF: early initiation of breastfeeding (EIB), exclusive breastfeeding under 6 months (EBF), and continued breastfeeding between 1 and 2 years (CBF12 and CBF24). Additionally, alternative estimates of the same indicators, slightly changing their definition, were calculated to test their robustness.ResultsThe WHO and UNICEF indicators for early initiation (EIB) primarily capture cases where breastfeeding is initiated “immediately” after birth, omitting those initiated within 0 or 1 hour. This discrepancy leads to substantial underestimation of levels in some regions, particularly South Asia, and in trends. Furthermore, sizable discrepancies between exclusive breastfeeding (EBF) indicators arise from the inclusion or exclusion of plain water in the definition, with significant variations across regions, especially in West and Middle Africa. However, continued breastfeeding indicators showed consistency across definitions, proving them robust for international comparisons and time trend estimations.ConclusionThis study highlights the importance of understanding how breastfeeding indicators are defined and calculated using DHS data. Researchers should be cautious when using WHO and UNICEF indicators for early initiation and exclusive breastfeeding, as they may underestimate prevalence due to their narrow definition. Continued breastfeeding indicators, on the other hand, are less affected by small changes in definitions and provide reliable measures for cross-country comparisons and trend analyses. These findings underscore the need for standardized robust definitions and transparent reporting of breastfeeding indicators in global health assessments.

The Hispanic paradox in child maltreatment: Does it fade over time?

BackgroundThe “Hispanic Paradox” refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to “fade” generationally. ObjectivesTo use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker (“fade”) for counties with fewer foreign-born Hispanics. DesignCensus data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status…). Participants and settingWe included national child maltreatment data at the county level. ResultsA negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship. ConclusionCounties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally.

Peningkatan Kemampuan Penggunaan Tata Bahasa Baku Pada Remaja Tingkat SMP/MTs Di Gampong Keude Lueng Putu Pidie Jaya

Introducing language to the public, especially teenagers, certainly requires a long process. This is done for the sake of creating the nation's children who understand their language, namely Indonesian. This Community service activity aims to encourage teenagers to understand standard Indonesian grammar and also to improve teenagers' ability to use standard Indonesian. There are three stages used in this community service method, namely the first stage is observation, the second stage is the core activity, namely providing training, and the third stage is the final activity, namely entering the activity evaluation stage. The level of use of varieties of Indonesian by teenagers in the school environment is still relatively low, the level of use of standard Indonesian by teenagers in the family environment is also still low, while the results of diagnostic tests on standard Indonesian grammar skills of teenagers in Keude Lueng Putu gampong are also still low. However, even though teenagers' abilities are still relatively low, this activity can show that teenagers have high enthusiasm for participating in activities and increased competence in answering Indonesian grammar questions that were previously not understood and misused. Therefore, training on standard grammar really needs to be given to teenagers in Gampong Keude Lueng Putu.

Mapping Functional Connectivity Signatures of Pharmacoresistant Focal Cortical Dysplasia-Related Epilepsy.

To determine common network alterations in focal cortical dysplasia pharmacoresistant epilepsy (FCD-PRE) using functional connectivity analysis of resting-state functional magnetic resonance imaging (rsfMRI). This is a retrospective imaging cohort from Children's National Hospital (Washington, DC, USA) from January, 2011 to January, 2022. Patients with 3-T MRI-confirmed FCD-PRE underwent rsfMRI as part of routine clinical care. Patients were included if they were age 5-22 years at the time of the scan, and had a minimum of 18 months of follow-up. Healthy, typically-developing controls were included from Children's National Hospital (n = 16) and matched from Human Connectome Project-Development public dataset (n = 100). A total of 42 FCD-PRE patients (20 M:22 F, aged 14.2 ± 4.1 years) and 116 healthy controls (56 M:60 F, aged 13.7 ± 3.3 years) with rsfMRI were included. Seed-based functional connectivity maps were generated for each FCD, and each seed was used to generate a patient-specific z-scored connectivity map on 116 controls. FCD-PRE patients had mutual altered connectivity in regions of dorsal attention, default mode, and control networks. Functional connectivity was diminished within the FCD dominant functional network, as well as in homotopic regions. Cluster specific connectivity patterns varied by pathological subtype. Higher FCD connectivity to the limbic network was associated with increased odds of Engel I outcome. This study demonstrates diminished functional connectivity patterns in FCD-PRE, which may represent a neuromarker for the disease, independent of FCD location, involving the dorsal attention, default mode, and control functional networks. Higher connectivity to the limbic network is associated with a seizure-free outcome. Future multicenter, prospective studies are needed to allow for much earlier detection of signatures of treatment-resistant epilepsy. ANN NEUROL 2024.

Epidemiological, Clinical, Etiological, and Therapeutic Aspects of Cerebral Palsy in Dakar

AbstractCerebral palsy is one of the most frequent causes of motor disability in children. The aim of our study was to characterize the epidemiological, clinical, paraclinical, etiological, and therapeutic aspects in Dakar. This was a retrospective and descriptive study from March 2010 to March 2020 at the Albert Royer National Children's Hospital and the Neurology Department of the Fann National University Hospital. We collected 913 patients, 13.7% of all pediatric neurology consultations, out of which 556 (60.9%) were males. The average age of the patients was 32.99 months (ranging between 25 days and 17 years). The most common subtype was isolated axial hypotonia (50%) followed by pyramidal (40.5%) and 45% had epilepsy. Brain imaging revealed cortico-subcortical atrophy in 15% of cases. Five hundred and fifty-two children (60.5%) had an electroencephalogram out of which 19.4% had diffuse irritative anomalies. In terms of treatment, 73% had received motor kinesitherapy. Sodium valproate was the most commonly used antiseizure medication at 76.67%. The average follow-up was 12 months. Seven hundred and ninety-two children (86.8%) were lost to follow-up and 5 children (0.5%) died. Psychomotor development improved in 219 children (13.4%) who acquired standing. Note that 267 children (30%) in a stable sitting position and 29 children had acquired language. Cerebral palsy is a disabling condition that needs to be diagnosed early and early interventions can improve the quality of life of the child.

Non-Invasive Ventilation for Children Affected by Duchenne Muscular Dystrophy in Ukraine

Background: Duchenne Muscular Dystrophy (DMD) poses significant challenges, especially in Low- and Middle-Income Countries (LMIC) with limited access to Non-Invasive Mechanical Ventilation (NIV), which prolongs life expectancy. Two years after Stage 1 of the successfull “1500 years of survival” NIV programme commenced with 8 DMD boys in Ukraine in 2021, this study further explores the Stage 2 of the programme in 2023. Method: DMD patients underwent a 5-day training program at the National Children’s Clinical Hospital “Okhmatdyt” in Kyiv, Ukraine, utilizing donated second-hand bilevel intermittent positive presure ventilators. Indications for NIV included: sleep-related symptoms, high Apnea-Hypopnea Index (AHI&gt;10 events/hour), decreased Forced Vital Capacity (FVC=50%), low minimum saturation during sleep (SpO2&lt;88%), or age above 17 years. Parallel Masterclass on NIV was conducted for Ukrainian healthcare professionals and patients’ parents. Findings: Thirteen DMD inpatients, aged (mean ± standard deviation) 14.8±2.6 years and FVC of 1.8±0.4L (65.5±22.8% predicted value) were enrolled. Criteria for NIV initiation were: age&gt;17 years (n: 4), FVC% =50% (n :6), AHI&gt;10 (n :2) and SpO2&lt;88% (n :5). Follow-up phone calls were conducted to monitor progress. Three months post-hospitalization, all 13 patients consistently adhered to nocturnal ventilator treatment with a mean use of 7.5 hours per night. Conclusions: Despite the lack of equipment and system of reimbursement, the implementation of the comprehensive Stage 2 training programme supplying NIV for DMD patients in an LMIC such as in Ukraine, was a successful experience. The next steps in the home NIV programme will take place in the coming years.

Association between nurse-child communication and family caregivers' global ratings to hospital: a retrospective study

PurposeEffective nurse-child communication is a fundamental aspect of delivering pediatric nursing care. Family caregivers' global ratings to hospital are considered a proxy-reported measure for assessing a child's inpatient stay experience. We investigate the associations between nurse-child communication and family caregivers' global ratings to hospital. Design and methodsA retrospective analysis of a national child patient experience survey data was conducted. Patient experience with nurse-child communication and the family caregivers' global ratings of hospital were measured using the Child Hospital Consumer Assessment of Healthcare Providers and Systems. Hierarchical linear models were constructed to examine the association between nurse-child communication measures and family caregivers' global ratings to hospital. ResultsData from 1010 patients at six National Regional Centers for Pediatric in China were collected. The overall rating of hospitals and the willingness to recommend the hospital showed increasing trends as the nurse-child communication score increased. How often nurses encourage children to ask questions was significantly associated with family caregivers' overall ratings of hospital and the family caregivers' willingness to recommend the hospital. ConclusionsEffective communication by nurses with the child is associated with significantly higher global ratings to the hospital by family caregivers during inpatient care. Encouraging children to ask questions is a promising contributor to caregivers' global ratings to hospital. Practice implicationsPediatric nurses should emphasis encouraging children to ask questions for effective communication in nursing practice. Future research is also needed to develop more targeted strategies to assist pediatric nurse to communicate with child better.

Measles resurgence in Armenia: unmasking health system vulnerabilities and crafting comprehensive eradication strategies - a review.

Measles is an acute febrile illness associated with rashes, fever and life-threatening complications. It is a vaccine-preventable disease with the Measles Mumps Rubella(MMR) vaccine but a recent global trend unveils a resurgence of measles in various parts of the world including Armenia. Measles was declared eliminated from Armenia in 2021 before reports of local outbreaks surfaced in 2023. The WHO identified discrepancies in the vaccination coverage during COVID-19. Measles also poses a great financial burden as a public health issue worldwide. Sociocultural factors impacting measles transmission are maternal education, healthcare access, migration, vaccine hesitancy, and socioeconomic status (Table 3). Efforts to control and eradicate measles from Armenia are run by a collaborative approach of national and international health bodies such as United Nations Children's Fund (UNICEF), WHO, Global Vaccine Alliance (GAVI), and the Ministry of Health. Thus, the resurgence of measles can be managed through widespread patient education, innovative approaches, strengthening the healthcare system and addressing vaccine hesitancy, sociocultural barriers, and humanitarian emergencies. This review investigates the complicated dynamics of measles inside Armenia's health system in depth. A thorough examination of measles incidence and immunization patterns highlights the shift from few cases and high vaccination rates to a comeback caused by imported viruses. The causes of its recurrence have been thoroughly investigated, including reduced immunization programs and vaccine hesitancy. The research delves further into the 'One Health' idea, assessing the possibility of interspecies transmission among nonhuman primates and examining the environmental factors that influence measles transmission. Among the challenges are weaknesses within Armenia's health system as well as the possibility of interruptions from the COVID-19 outbreak. In measles vaccination status, the combination of maternal education, postnatal care, and socioeconomic variables exposes the larger drivers at work. The study concludes with a comprehensive set of public health policy recommendations covering vaccination promotion, surveillance, healthcare provider education, public awareness, international collaboration, data analysis, law enforcement, emergency preparedness, research, and coordination. The research sheds light on the tangled web of measles dynamics, health system resilience, and contextual subtleties via this multifaceted approach, inviting readers to investigate the multiple strategies required for eliminating measles in Armenia.

Using a participatory action research approach to explore, understand and evaluate well-being among children living in socially deprived areas in Southern Sweden: a study protocol

IntroductionResearch suggests that participating in after-school leisure activities has been related to promoting health, well-being and safety among children living in disadvantaged neighbourhoods. The United Nations Child Rights Convention emphasises...

Food neophobia scores at 8 Years and associations with nutrition-related behaviors at home in early life: Findings from a New Zealand contemporary birth cohort

Food neophobia (FN) reduces nutritional adequacy and variety which poses a significant concern for children's health and well-being We described the FN scores among 8-year-olds and examined its associations with nutrition-related behaviors at 45 months within the Growing Up in New Zealand cohort (n = 4621). FN was estimated using the Food Neophobia Scale (FNS). Mean FNS scores between variable categories were compared using t-tests for independent samples and ANOVA. Associations between FNS scores at 8 years and nutrition-related behaviors at 45-months were examined using multivariate linear regression. The mean (standard deviation) FN score was 46.2 (15.2) with statistically significant differences by sex (boys = 47.6 (15.7), girls = 43.8 (14.2), p=<0.001). For all children, in models adjusted by breastfeeding duration and sociodemographic characteristics: children who sometimes and never/almost never ate the same foods as their parents, scored, on average, 5.8 and 11 points higher in the FNS (versus those who did always/almost always); children who occasionally/never found mealtimes enjoyable scored on average 3.6 points lower in the FNS (versus mostly/quite often); children who always/almost always had the television on during mealtimes scored on average 2.7 higher in the FNS (versus never/almost never). In comparison to children who mostly/quite often had time to talk to others during mealtimes, those who never/occasionally did it scored on average higher points in the FNS overall (1.46 points higher) and within girls (1.73 points higher). These findings support the eating behavior statements in the National Children's Food and Nutrition Guidelines, which emphasize early exposure to food variety, limiting mealtime distractions, and acknowledge that parental role modeling shapes children's nutrition-related behaviors. Early adoption of preventative interventions for reducing FN in early and middle childhood are needed.

Examining the characteristics of children who experience contact with the youth justice system in Queensland: implications for the minimum age of criminal responsibility

ABSTRACT In jurisdictions such as Queensland, where the minimum age of criminal responsibility (i.e., 10 years of age) is out of step with international law and Australian human rights obligations, there are significant concerns about the criminalisation of children. These concerns include the potential for ensnaring young people, particularly First Nations children, into the criminal justice system rather than addressing their underlying needs. We use a birth cohort of individuals registered as born in Queensland in 1990 and followed up to age 24 years to examine the characteristics of young people who experienced their first youth justice system contact between ages 10 and 16 years. First Nations youth were significantly overrepresented among those with the earliest ages of contact (i.e., 10–13 years). Early youth justice contact was largely for minor and less serious forms of offending (i.e., property-related), but those with the earliest ages of onset typically went on to experience more persistent and serious offending outcomes up to age 24 years. Raising the minimum age of criminal responsibility alongside the implementation of culturally relevant early intervention, diversion and support services is likely to significantly reduce the overrepresentation of First Nations people in the criminal justice system.

A preliminary retrospective evaluation of screening and diagnosis of ornithine transcarbamylase deficiency in high-risk patients at a referral center in Vietnam

IntroductionTo date, newborn screening (NBS) for proximal urea cycle disorders, including Ornithine transcarbamylase deficiency (OTCD), was not recommended due to the lack of appropriate tests and insufficient evidence of the benefits. This study aimed to investigate the potential of tandem mass spectrometry (MS/MS) for OTCD screening and its value in guiding further investigation to obtain a final diagnosis in high-risk patients. MethodsThe study included patients with OTCD referred to the National Children's Hospital between April 2020 and November 2023. A retrospective evaluation of amino acid concentrations measured by MS/MS and their ratios in patients with early-onset and late-onset OTCD was conducted. ResultsWhile all ten early-onset cases had glutamine concentrations above the upper limit, only five of them had citrulline concentrations below the lower limit of the reference interval. Only two late-onset cases had elevated glutamine levels, while all had citrulline within reference intervals. The Cit/Phe ratio was decreased, and the Gln/Cit and Met/Cit ratios were increased in all early-onset OTCD cases, while they were abnormal in only one late-onset case. ConclusionsThe preliminary results suggest that hyperglutaminemia, in combination with low or normal citrulline concentrations and specific ratios (Gln/Cit, Met/Cit, and Cit/Phe), can serve as reliable markers for screening early-onset OTCD in high-risk patients. However, these markers proved less sensitive for detecting the late-onset form, even in symptomatic patients.

Inequality in breastfeeding and complementary feeding practices in Argentina by household income level in 2018-2019.

Introduction. Diet quality is a right related to survival, healthy growth, prevention of chronic diseases, and malnutrition in all its forms. The objective of this study was to analyze breastfeeding and feeding practices in children younger than 2 years from urban areas of Argentina in 2018-2019 according to their household income level. Population and methods. Secondary analysis of data of the Second National Survey on Nutrition and Health (ENNyS2) of 2018-2019. Breastfeeding and complementary feeding indicators proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) were analized. Data were stratified by household income level. Results. The analysis included 5763 children younger than 24 months old. Although 97% was ever breastfed, only 47% of infants younger than 6 months were exclusively breastfed the previous day and 48% continued with breastfeeding after 1 year old, with a higher prevalence in low-income children. The previous day, 23% of children aged 6 to 23 months did not eat any fruit or vegetable, 60% consumed unhealthy foods, and 50% consumed sweet beverages. The consumption of sweet beverages and the absence of fruit and vegetables were higher in low-income households. Conclusion. The quality of children's diet is far from the recommendations and is conditioned by income. Early initiation of breastfeeding, minimum dietary diversity, fruit and vegetable consumption are lower and sweet beverage consumption is greater in impoverished sectors.

Epidemiological changes of invasive fungal disease in children with cancer: Prospective study of the National Child Program of Antineoplastic Drugs network, Chile.

Invasive fungal diseases (IFD) are high morbidity and mortality infections in children with cancer suffering episodes of high-risk febrile neutropenia (HRFN). IFD epidemiology has changed in the last two decades, with an increasing incidence in recent years due to the growing number of immunocompromised children at risk for IFD. The aim of this study was to evaluate the incidence of IFD in children with cancer in the period 2016-2020 compared to 2004-2006 in six hospitals in Chile. Prospective, multicentre study, carried out between 2016 and 2020 in six hospitals in Chile. The defined cohort corresponds to a dynamic group of HRFN episodes in patients <18 years old with cancer, who at the fourth day of evolution still presented fever and neutropenia (persistent HRFN). Each episode was followed until resolution of FN. The incidence of IFD was calculated between 2016 and 2020 and compared with data obtained in the period 2004-2006. The incidence rate was estimated. A total of 777 episodes of HRFN were analysed; 257 (33.1%) were considered as persistent-HRFN occurring in 174 patients. The median age was 7 years (IQR: 3-12 years) and 52.3% (N = 91) were male. Fifty-three episodes of IFD were detected: 21 proven, 14 probable and 18 possible. Possible IFD were excluded, leaving 239 episodes of persistent-HRFN with an IFD incidence of 14.6% (95% CI 10.5-19.9) and an incidence rate of 13.6 IFD cases per 1000 days of neutropenia (95% CI 9.5-20.0). Compared to 2004-2006 cohort (incidence: 8.5% (95% CI 5.2-13.5)), a significant increase in incidence of 6.1% (95% CI 0.2-12.1, p = .047) was detected in cohorts between 2016 and 2020. We observed a significant increase in IFD in 2016-2020, compared to 2004-2006 period.

Efficacy of zinc as an adjuvant therapy in acute pneumonia in children of age 2 months to 2 years: A randomized controlled trial

Background: Pneumonia is the most common Illness affecting infants and children globally. Childhood pneumonia has been identified as the major “forgotten killer of children” by UNICEF and the WHO. The WHO and United Nations Children’s Fund (UNICEF) in 2013, published the integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) which outlined a framework for ending preventable child deaths due to diarrhoea and pneumonia by 2025. Zinc is a vital micro element that is essential for a variety of fundamental biological processes due to its function as a transition metal, cofactor, structural component, and signalling molecule. Zinc is also an essential component of antibacterial immunity. The impaired immunocompetence due to low zinc states enhances the establishment of a particular infection due to a reduction in the clearance of infectious agents. Recommend zinc nutritional intake is 10-20mg/day for children. It is estimated that 17-20% of the world’s population may be zinc deficient. Zinc deficiency is common among children in developing countries because of inadequate food intake, particularly from animal source and limited bioavailability from local diet. It has been proposed that zinc can be a real potential in the prevention of pneumonia morbidity and mortality. Objective: To study the effect of zinc supplementation as an adjuvant therapy on outcome of pneumonia. Method: We conducted a randomised controlled trial from march 2023 to february 2024. All children in the the age group of 2 months to 2 years, who presented with the features of pneumonia to the department of Paediatrics in Akash institute of medical sciences and research centre Devanhalli, Bangalore rural. Ethics consent was obtained from Institutional ethical committee. Demographic details such as name, age, gender along with clinical profile was taken. After admission, detailed history and physical and systemic examination were carried out and necessary data collected. Sample size being 50 cases, they were divided in two groups as case group (zinc group) and control group by stratified randomisation, 25 participants being in each group. Enrolled children were given standard treatment for pneumonia in the form of oxygen, intravenous fluids, bronchodilators, parenteral antibiotics. Enteral feeds were started once the child respiratory distress improved, oxygen saturations greater than 93%, baby was able to tolerate feed. Zinc group received 20 mg of elemental zinc per day as a single dose for 7 days. Result : Out of the total 50 cases, two groups were divided with 25 cases in zinc group and 25 cases in non-zinc group. In zinc group 6 cases (50%) took 24-48 hours for disappearance of symptoms, another 3 cases (26%) less than 24 hours, in 1 case time for disappearance of symptoms was 48-72 hours, another case which took 72-96 hours. The mean duration of time taken for disappearance of danger signs was 42.33 ± 13.89 hours. In the non-zinc group (36%) 5 cases took 24-48 hours for disappearance of danger signs, 3 cases (22%) which took 48-72 hours and 2 cases (14%) which took 96-120 hours, 2 more cases (14%) which took 120-144 hours. The mean duration of hospital stay in non-zinc group was 62.28 ± 10.84 hours which is comparatively more than that of zinc group. Conclusion: This study concluded that zinc supplementation shortens the time taken for resolution of respiratory distress and resolution of symptoms. However, it was not found to be of much help in improving oxygen saturation. It also did not show any significant decrease in time taken for disappearance of danger signs and duration of hospital stay.